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PMSMA Excel FORMATS

This document contains a monthly reporting format for the Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) in Anantapuram district. It includes data on the number of pregnant women who received services during the campaign organized in the reporting month, including the number who received antenatal care, investigations, medicines, and counseling. It also provides details on high-risk pregnancies identified and referrals made for further treatment. The format is to be used to collect service delivery data during the PMSMA using only numbers.

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5K views

PMSMA Excel FORMATS

This document contains a monthly reporting format for the Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) in Anantapuram district. It includes data on the number of pregnant women who received services during the campaign organized in the reporting month, including the number who received antenatal care, investigations, medicines, and counseling. It also provides details on high-risk pregnancies identified and referrals made for further treatment. The format is to be used to collect service delivery data during the PMSMA using only numbers.

Uploaded by

sri sri
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
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Monthly Reporting Format – Pradhan Mantri Surakshit Matritva Abhiyan

Name of DISTRICT-Anantapuram

NAME OF THE INSTITUTION-


Month & Year:-

Service Delivery during PMSMA*

Number
Number of of P.W
Number of P.W who
P.W who who received
received received
S.No. Data elements (Number of Pregnant Women ) care in
care in care in Other
rural areas urban govt.
under NHM areas under health
NHM facilities

2nd/ 3rd trimesters of pregnancy Line-listed by


1.        ANM/ ASHA
2.        Received Antenatal care
a) Received 1st ANC
b) Received 2nd ANC
c) Received 3rd ANC
d) Received 4 or more ANCs

Out of total who received ANC, those who have


3.        already received ANC in previous rounds of PMSMA

4.        Registered on RCH portal


5.        Issued MCP card
Examination of Pregnant Women (P.W)
6.        Weight checked
7.        Blood pressure recorded
8 Abdominal examination
Investigations
9 Haemoglobin checked
10 Blood Sugar checked
Blood Sugar already checked during previous ANC
11 visits
12 Urine examination
13 Tested for HIV
Already been tested for HIV during previous ANC
14 visits
15 Tested for syphilis
Already been tested for syphilis during previous ANC
16 visits
17 Ultrasound conducted
Ultrasound already conducted during previous ANC
18 visits
Medicines provided to Pregnant Women
19 Distributed IFA during
20 Distributed Calcium supplementation
21 Received/completed Tetanus Toxoid dose
Identification of High Risk factors
a) Identified with anaemia
b) Identified with severe anaemia
c) Identified with pregnancy induced hypertension
d) Identified with diabetes
e) Identified with HIV
f) Identified with syphilis
g) Identified with hypothyroidism
h) Identified with any other high risk factor
22 Total Number of high risk pregnancies identified
P.W with high risk factors referred for further
23 treatment
24 P.W with high risk factors treated
Counselled on Birth Preparedness and complication
25 readiness

NOTE- USE NUMBERS ONLY PMSMA FORMAT


DON'T USE YES/NO
[email protected]

MEDICAL OFFICER
Anantapuram
t Matritva Abhiyan

Number
of P.W
who
received Total Remarks
care in
Private
Health
Facilities

No. of P.W. line listed


for PMSMA

During current
round
Out of total who
received ANC
Out of total who
received ANC
Out of total who
received ANC
Out of total who
received ANC
This is subset of
point 2 and is not
applicable for1st
round of PMSMA

All P.W must be


registered on RCH
and issued MCP card

During current
round
During current
round
During current
round

During current
round
During current
round

During current
round
During current
round
During current
round

During current
round

n
During current
round
During current
round
During current
round

Total of a) to h)
above

MEDICAL OFFICER
Anantapuram
PMSMA - DETAILS OF HIGH RISK PREGNANT WOMEN PROVIDED SERVICE
NAME OF THE INSTITUTION-

Sl.No. Name of the Name of the High Risk Contact Ph.No. Factors for EDD
Institution Pregnant women and high risk
Address

1
2
3
4
5
6
7
7
8
9
10
11
anantapursofw2@gmailcom
MEN PROVIDED SERVICES ON 09-08-19 ANANTHAPURAMU DISTRICT.
MONTH- YEAR

Name of the Idetified Name of the Uterus Fetal BP HB Lab tests USG
Escort person & Institution facility size in heart done done
provided
Designation for delivery specialist weeks sound Yes/No Yes/No
services on
10-
9-2018
Details of
treatment
given

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